Download Guidance for the Public Health Management of Infection with

Summary of the public health
management of a suspected case
of VTEC infection
Summary of the early clinical
management of suspected VTEC
infection
The public health management of a
suspected case of VTEC infection is
complicated and has so many variables
that it cannot be addressed in detail in an
algorithm.
It is beyond the scope of an algorithm to
describe even the early clinical management
of suspected VTEC infection in detail.
This algorithm should therefore be used in
conjunction with HPS’ “Guidance on the
Public Health Management of Infection with
verotoxigenic Escherichia coli O157”.
In particular, the Glossary in the Guidance
may be helpful in defining, for example, the
different categories of “case”.
The Guidance should be consulted for:
This algorithm should therefore be used in
conjunction with HPS’ “Guidance on the
Public Health Management of Infection with
verotoxigenic Escherichia coli O157”.
The threshold for suspicion of VTEC infection
should be low, and the diagnosis seriously
considered when there is acute bloody
diarrhoea. Specialist advice should be sought
when this symptom occurs in an especially
vulnerable person.
Guidance for the Public Health
Management of Infection with
Verotoxigenic Escherichia coli
(VTEC)
Quick Reference Guide
Health Protection Network
Scottish Guidance
Revised February 2013
•Activities that should be carried out
at all stages of the public health
management, including communications
with microbiological colleagues and HPS,
and the provision of appropriate infection
control advice to cases, contacts, and
others.
•The management of potential outbreaks,
including the investigation of potential
common exposures, and the subsequent
management of the suspected source.
3
2013
Edition
Health Protection Network
Supported by Health Protection Scotland
Health Protection Network site:
http://www.hps.scot.nhs.uk/about/HPN.aspx
© Health Protection Network 2013
See full guidance document for further
copyright information: http://www.hps.scot.
nhs.uk/giz/guidelinedetail.aspx?id=39336
Designed and typeset by:
Graphics Team, Health Protection Scotland
No
No
No
No further action on
asymptomatic contacts
No
Yes
Exclude until
microbiologically
clear
Exclude until
48 hours
symptom free
Yes
No
Is confirmed case or highly
likely case in Groups A-D?
Yes
Is suspected case,
asymptomatic contact
or associated suspected
case microbiologically
confirmed?
Monitor until
confirmed, highly
likely or recovered
No
Is suspected case or
associated suspected
case highly likely?
No
No further action
on associated
suspected cases
No
Are there any?
Are there any?
Yes
Seek microbiological
confirmation (of suspected
case, asymptomatic
contact and associated
suspected cases)
Yes
Seek associated
suspected cases
Treat as early clinical
management algorithm
Manage potential
outbreak
as in Guidance
Significant likelihood
of VTEC but less likely
to develop HUS – treat
as clinically indicated
Unlikely to be
VTEC – treat as
clinically indicated
Almost certainly
not VTEC – treat
as clinically indicated
Seek asymptomatic contacts
Suspected case of VTEC infection
Summary of public health management of a suspected case of VTEC infection
Treat as medical emergency.
Consult specialist clinician (ID physician/paediatrician)on need for admission or
clinical management and investigation e.g. monitoring of blood parameters
Yes
OR
Over 60 years of age
OR
Suffering severe abdominal pain
Under 16 years of age
Is the patient:
Send stool and report to HPT
Antibiotics/anti-motilities/NSAIDs/opiates are contra-indicated
Yes
Is stool grossly bloody/uniformly blood-stained?
Yes
Consider sending stool. Enquire about associated cases and
biologically plausible exposures. Provide advice on hygiene
Yes
Is this likely to be infectious?
Yes
Patient presents with acute diarrhoea
Early clinical management of suspected infection